急性ST段抬高性心肌梗死合并2型糖尿病患者PCI术后他汀类药物强化治疗对肾脏的影响

Effect of Intensive Statin Therapy on Kidney in Patients with Acute ST-segment Elevation Myocardial Infarction and Type 2 Diabetes after PCI

目的探讨急性ST段抬高性心肌梗死(STEMI)合并2型糖尿病患者PCI术后他汀类药物强化治疗对肾脏的影响。方法选择2019年8月-2020年8月在该院就诊的急性STEMI合并2型糖尿病患者80例为研究对象,根据PCI术后是否服用高剂量阿托伐他汀钙将患者分为常规治疗组(40例)和强化治疗组(40例)。常规治疗组术后在其他常规治疗基础上给予口服阿托伐他汀钙20 mg/d治疗,强化治疗组在其他常规治疗基础上给予阿托伐他汀钙40 mg/d治疗。分别测定两组不同时间血清肌酐(Scr)、尿素氮(BUN)、α-肿瘤坏死因子(TNF-α)、超敏C-反应蛋白(hs-CRP)、尿微量白蛋白(mAlb)、尿微量白蛋白/肌酐(ACR)、24 h尿蛋白定量、血肌酐清除率(Ccr)、肾动脉阻力指数(RI)、肾血管收缩期峰值流速(PSV)等指标,评价不同剂量阿托伐他汀钙强化治疗对肾脏的保护作用。结果术后3个月,强化治疗组患者的Scr值显著低于常规治疗组[(68.29±2.11)μmol/L vs(70.02±2.31)μmol/L],BUN值显著低于常规治疗组[(6.98±1.76)mmol/L vs(7.23±1.22)mmol/L],mAlb值显著低于常规治疗组[(25.78±1.97)mg/L vs(27.56±1.93)mg/L],ACR值显著低于常规治疗组[(3.59±0.89)mg/mol vs(3.75±0.56)mg/mol],24 h尿蛋白定量值显著低于常规治疗组[(0.54±0.10)g/24 h vs(0.56±0.34)g/24 h],Ccr值显著高于常规治疗组[(68.00±2.21)mL/min vs(66.00±4.32)mL/min],TNF-α值显著低于常规治疗组[(15.00±2.73)ng/L vs(16.00±3.42)ng/L],hs-CRP值显著低于常规治疗组[(17.00±2.01)mg/L vs(17.98±1.11)mg/L],RI值显著低于常规治疗组[(0.69±0.05)%vs(0.72±0.12)%],PSV值显著低于常规治疗组[(120.00±6.00)cm/s vs(125.00±9.00)cm/s],差异有统计学意义(P<0.05)。结论阿托伐他汀钙40 mg/d治疗对急性STEMI合并2型糖尿病PCI术后患者肾功能保护作用效果明显优于20 mg/d,他汀类药物强化治疗在急性STEMI合并2型糖尿病患者PCI术后患者中具有肾脏功能的保护作用。

Objective To investigate the effects of intensive statin therapy on the kidneys of patients with acute ST-segment elevation myocardial infarction(STEMI)combined with type 2 diabetes after PCI.Methods Eighty patients with acute STEMI combined with type 2 diabetes who were treated at the Fifth People's Hospital of Datong City from August 2019 to August 2020 were selected as the research subjects.The patients were divided according to whether they took high-dose atorvastatin calcium after PCI:the conventional treatment group(40 cases)and the intensive treatment group(40 cases).The conventional treatment group was given oral atorvastatin calcium 20 mg/d on the basis of other conventional treatments,and the intensive treatment group was given atorvastatin calcium 40 mg/d on the basis of other conventional treatments.Serum creatinine(Scr),urea nitrogen(BUN),α-tumor necrosis factor(TNF-α),high-sensitivity C-Reactive protein(hs-CRP),urinary microalbumin(mAlb),urinary microalbumin/creatinine(ACR),24 h urine protein quantification,blood creatinine clearance(Ccr),renal artery resistance index(RI),renal vascular Peak systolic flow velocity(PSV)and other indicators in two groups at different time were measured to evaluate the protective effect of different doses of atorvastatin calcium intensive treatment on the kidneys.Results Three months after the operation,the Scr value of the patients in the intensive treatment group was significantly lower than that of the conventional treatment group[(68.29±2.11)μmol/L vs(70.02±2.31)μmol/L],and the BUN value was significantly lower than that of the conventional treatment group[(6.98±1.76)mmol/L vs(7.23±1.22)mmol/L],the mAlb value was significantly lower than that of the conventional treatment group[(25.78±1.97)mg/L vs(27.56±1.93)mg/L],the ACR value was significantly lower than the conventional treatment group[(3.59±0.89)mg/mol vs(3.75±0.56)mg/mol],the 24 h urine protein quantitative value was significantly lower than the conventional treatment group[(0.54±0.10)g/24 h vs(0.56±0.34)g/24 h],Ccr value was significantly higher than the conventional treatment group[(68.00±2.21)mL/min vs(66.00±4.32)mL/min],TNF-αvalue was significantly lower than the conventional treatment group[(15.00±2.73)ng/L vs(16.00±3.42)ng/L],the hs-CRP value was significantly lower than that in the conventional treatment group[(17.00±2.01)mg/L vs(17.98±1.11)mg/L],RI value was significantly lower than conventional treatment group[(0.69±0.05)%vs(0.72±0.12)%],PSV value was significantly lower than conventional treatment group[(120.00±6.00)cm/s vs(125.00±9.00)cm/s],the difference was statistically significant(P<0.05).Conclusion The protective effect of atorvastatin calcium 40 mg/d on renal function of patients with acute STEMI complicated with type 2 diabetes after PCI is significantly better than that of 20 mg/d,and intensive treatment with statins has protective effect on renal function in patients with acute STEMI complicated with type 2 diabetes after PCI.